Co-existence of Multiple Resistance Mechanisms in Clinical Isolates of Carbapenem-Resistant Pseudomonas Aeruginosa

Abstract

Introduction: Multidrug resistance phenotype of Pseudomonas aeruginosa utilizes several resistant mechanisms to overcome the action of antibiotics. This phenotype is caused by several resistance mechanisms or a combination of thereof. This study aimed to evaluate various resistance mechanisms by phenotypic methods.

Materials and Methods: Carbapenem-resistant P. aeruginosa were included in this study. Antimicrobial resistance mechanisms such as efflux pump activity, reduced outer membrane permeability (OMP), various beta-lactamase activities, and biofilm formation ability of clinical P aeruginosa isolates were determined by phenotypic methods.

Results: Of the P aeruginosa isolates, 33.7% (n= 33/98) had a positive efflux pump activity. The co-existence of positive efflux pump activity and Metallo beta-lactamase (MBL) production was detected in 30.3% (10/33) of the isolates. In 34.7% of the clinical P. aeruginosa isolates, reduced OMP was detected and 70.6% of them were also biofilm producers. Totally 21.4% (21/98) of P aeruginosa isolates were evaluated as extended-spectrum beta-lactamase (ESBL) positive. AmpC beta-lactamase was detected in 15.3% (n= 15/98) of the clinical P. aeruginosa isolates. MBL activity was detected in 33.7% (n= 33/98) of the clinical P. aeruginosa isolates. Of the MBL-positive isolates, 69.7% were biofilm producers. The co-existence of MBL and reduced OMP was detected in 36.4% (n= 12/33).

Conclusion: High resistance of P. aeruginosa was attributed to several resistance mechanisms or a combination of thereof. This infections caused by multidrug-resistant (MDR) P. aeruginosa are difficult to treat due to the co-existence of different resistance mechanisms.